What I would do differently if I was diagnosed with osteopenia or osteoporosis

If I could go back in time, there are quite a few things I would do differently. Not because I did everything wrong before my diagnosis — I didn't.

I exercised regularly. I went to Zumba. I did Barre. I had a Personal Trainer. I was active.

But looking back, I can see some very obvious gaps.

And those gaps are exactly what I now see in many of the women I work with.

1. I would do a really honest audit of how much I was actually challenging my bones

I was exercising around three times a week, but only one of those sessions was strength training. Even then, I was much more focused on the cardio element and making sure I was burning enough calories.

And there was another problem.

Outside those three sessions, I was sitting down. A lot.

I worked at a desk and when work was particularly busy, I could quite easily get to the end of the day having barely moved.

I knew myself well enough to know that my work was always going to take priority. It crept into evenings and weekends and, despite my best intentions, I wasn't suddenly going to become someone who stopped work to go lift some weights.

So I had to stop looking at the three workouts in isolation and look at the whole picture.

In my case, I eventually changed my job and became a PT.

That might sound a bit drastic, but I'd been wanting to make a change for a while and I knew another desk job wasn't going to help me prioritise my health.

I had to be honest with myself.

Nothing was going to change unless I re-prioritised my health.

This is something I see with clients all the time.

Many are genuinely very active but also have busy lives juggling kids, elderly parents, demanding jobs and they are pulled in every direction.

So the question isn't necessarily:

“Am I active?”

It's:

“What is missing?”

For many women, that missing piece is progressive strength training with a focus on building muscle and challenging bone. You don't necessarily need to throw away everything you're already doing.

You need to identify the gap and fill it.

And sometimes that means admitting that you need to prioritise yourself and your future health.

You can't be the backbone of your family if, as you age, you lose muscle, lose bone and your quality of life starts to diminish.

If you're not confident with strength training, get some help. Find someone who understands women 40+ & bone health and what your body needs now; rather than simply someone who wants you to burn calories and push yourself to the max.

2. I would take a much closer look at what I was eating and what I was actually getting from it

After my diagnosis, I started paying much more attention to my nutrition.

Not because I suddenly wanted a cupboard full of vitamins.

I wanted to know whether I was actually getting the nutrients my bones need.

Calcium and Vitamin D are the obvious ones, but protein is something I pay much more attention to now too.

A recent 2026 study found that in older women receiving osteoporosis treatment, low protein intake appeared to blunt some of the benefits of antiresorptive medication, particularly in women eating less than 0.8g of protein per kg of body weight per day.

And there are other nutrients involved in bone health too, including magnesium, vitamin K, vitamin C and the B vitamins.

For me personally, I discovered that my vitamin D levels were low and my iron levels weren't great. Those were things I needed to address.

That doesn't mean everyone needs to start taking vitamin D, iron, magnesium, calcium and everything else they can find.

It means knowing where your gaps are is useful.

Sometimes that means looking at your diet. Sometimes it means discussing blood tests or supplementation with your GP or healthcare professional.

When you have low bone density, I think it's worth being much more specific about this rather than simply thinking:

“I eat healthily, so I'm probably fine.”

3. I would get fully informed about my diagnosis — including my medication

This is one I wish I'd appreciated earlier.

“Osteopenia” or “osteoporosis” is only part of your story.

I'd want to understand what my DEXA results actually meant, my individual fracture risk, what other risk factors I had and whether I needed medical treatment alongside exercise and nutrition.

And if I was offered medication, I'd want to understand exactly what I was taking, why I was taking it, how long it was normally prescribed for and what happens if I stop taking it early.

This matters because persistence with osteoporosis medication is actually a big problem.

A UK study of 72,256 women found that only 43.6% were still taking osteoporosis treatment at 12 months, 31% at 2 years and 13.1% at 5 years. For oral bisphosphonates, persistence at two years was only 28% - that's a huge drop-off (because most are prescribed for around 5 years to have a benefit.)

And some osteoporosis medicines have very specific considerations around stopping or taking treatment breaks, so I wouldn't simply stop because I was experiencing side effects or because I'd decided I felt better.

I'd go back to my doctor and discuss my options.

I'd also want to understand HRT properly.

I take HRT and intend to continue it because, for me, the benefits go beyond my bones. If you are taking it what I hear a lot, is women telling me they have been told to stop after 5 years.

There is no fixed maximum duration for HRT.

NHS guidance says the length of treatment should be reviewed according to your individual benefits and risks, with regular reviews rather than an automatic five-year cut-off. Did you know the bone-strengthening and density protection you had while on HRT fades within 12 months of stopping it, something which no one talks about!

So my advice would be:

Get informed. Ask questions. Understand your options.

And don't stop prescribed treatment without discussing it with the person managing your care in relation to how will this affect my bone health?

So what was the biggest change?

I prioritised my own health!

I made a commitment to the future me that I was going to be as healthy, strong and active as I could be for as long as possible.

What also drove me was seeing my mum in hospital with a hip fracture, then in a wheelchair and seeing the impact that has had on her quality of life and on all of us as a family.

I can't control everything that happens to me as I get older.

But I can make choices now that give me a better chance of staying strong and independent.

I'm hoping I can rewrite a different future for myself. And I hope you find your reasons to make these changes too.